{"id":2860,"date":"2020-03-26T04:37:17","date_gmt":"2020-03-26T09:37:17","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=1235"},"modified":"2025-05-09T16:10:17","modified_gmt":"2025-05-09T21:10:17","slug":"pruritus","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/pruritus\/","title":{"rendered":"Pruritus"},"content":{"rendered":"<h4>Etiology<\/h4>\n<ul>\n<li>Common abnormalities in ESRD play a role in pathogenesis:\n<ul>\n<li>Xerosis (dry skin)<\/li>\n<li>Peripheral neuropathy<\/li>\n<li>Hypercalcemia<\/li>\n<li>Hyperphosphatemia<\/li>\n<li>Hypermagnesemia<\/li>\n<li>Zinc depletion<\/li>\n<li>Hypervitaminosis A<\/li>\n<\/ul>\n<\/li>\n<li>No correlation found between standard biochemical tests (blood urea nitrogen, creatinine, calcium, phosphate, parathyroid hormone) and uremic pruritus<sup>2<\/sup><\/li>\n<li>A possible role for chronic inflammation<sup>3<\/sup><\/li>\n<li>A possible relationship between pruritus and type of dialyzer is not clear<sup>4<\/sup><\/li>\n<\/ul>\n<h4>Treatment <sup>5-8<\/sup><\/h4>\n<ul>\n<li>Empirical, individualized and often ineffective<\/li>\n<li>Skin emollients, capsaicin, H-1 receptor antagonist, phototherapy (UVB)<\/li>\n<li>Newer drugs: Thalidomide, nicergoline, lidocain, mexiletine, cholestyramine, cromolyn sodium and Gabapentin<\/li>\n<li>Other modalities: Acupuncture, electric needle stimulation and sauna, parathyroidectomy and renal transplantation in recalcitrant cases<\/li>\n<\/ul>\n<h4>Prevention<\/h4>\n<ul>\n<li>Optimizing calcium, phosphate, magnesium, PTH and delivered dose of dialysis (greatly reduced at Kt\/V &gt; 1.5<sup>9<\/sup>)<\/li>\n<li>Avoidance of dialysis related factors<sup>10<\/sup>\u00a0such as iodine, ethylene oxide.\u00a0 Find out any allergy to heparin.<\/li>\n<li>Biocompatible membrane can be used preferably<\/li>\n<li>Consider parathyroidectomy. Renal transplantation is the only definitive treatment.<\/li>\n<\/ul>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4>References:<\/h4>\n<ol>\n<li>Lugon JR.\u00a0 Uremic pruritus:\u00a0 A review. <em>Hemodial Int<\/em> 9:180-188, 2005<\/li>\n<li>Virga G, Mastrosimone S, Amici G, Munaretto G, Gastaldon F, Bonadonna A. Symptoms in hemodialysis patients and their relationship biochemical and demographic parameters. <em>Int J Artif Organs<\/em> 21:788-793, 1998<\/li>\n<li>Kimmel M, Alscher DM, Dunst R, Braun N, Machleidt C, Kiefer T, Stulten C, van der KH, Pauli-Magnus C, Raub U, Kuhlmann U, Mettang T. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. <em>Nephrol Dial Transplant<\/em> 21:749-755, 2006<\/li>\n<li>Rollino C, Goitre M, Piccoli G, Puiatti P, Martina G, Formica M, Quarello F, Bernengo MG. What is the role of sensitization in uremic pruritus? <em>Nephron<\/em> 57: 319-322, 1991<\/li>\n<li>Schwartz IF, Iaina A. Management of uremic pruritus. <em>Semin Dial<\/em>\u00a0 13:177-180, 2000<\/li>\n<li>Urbonas A, Schwartz RA, Szepietowski JC. Uremic pruritus-an update. <em>Am J Nephrol<\/em>\u00a0 21:343-350, 2001<\/li>\n<li>Rosner MH. Cromolyn sodium: A potential therapy for uremic pruritus? <em>Hemodial Int<\/em> 10:189-192, 2006<\/li>\n<li>Manenti L, Vaglio A. Gabapentin for uraemic pruritus<br \/>\n232. <em>Nephrol Dial Transplant<\/em> 20:1278-1279, 2005<\/li>\n<li>Masi CM, Cohen EP. Dialysis efficacy and itching in renal failure. <em>Nephron<\/em>\u00a0 62: 257-261, 1992<\/li>\n<li>Kessler M, Moneret-Vautrin DA, Cao-Huu T, Mariot A, Chanliau J. Dialysis pruritus and sensitization. <em>Nephron<\/em>\u00a0 60:241-251, 1992<\/li>\n<\/ol>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[128],"tags":[60],"language":[41],"articles":[230],"class_list":["post-2860","article","type-article","status-publish","format-standard","hentry","category-articles","tag-intradialytic","language-english","articles-hemodialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Pruritus - AREP Asia Pacific<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/pruritus\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pruritus - 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